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Bigger Hospital Rooms for Bigger Patients

When the revamped Parkland Hospital in Dallas opened recently, each of the 862 single-patient rooms in the sprawling new 17-story tower was ready to accommodate the growing number of obese patients that hospitals across the country increasingly care for.

“We designed with this idea of the universal patient in mind,” said Jim Henry, an associate vice president of the architectural consulting firm HDR, which worked on the new building. “Any patient can go into any room. At this hospital, a patient doesn’t feel, ‘I’m going into a bariatric room.’ ”

“The bariatric population” — typically defined as patients having a body mass index of 40 or higher — “wasn’t an afterthought,” said Kathy Harper, vice president of clinical coordination, new campus construction, at Parkland. “They’re a very special population. We thought a lot about their needs and how to accommodate them.”

It’s a trend at hospitals across the country, though few on the scale of Parkland.

“Most hospitals we are building are providing an increasingly larger percentage of rooms that can accommodate the larger person,” said Nancy Connolly, a senior executive at Hammes Company, a hospital consulting group. “In the last five to 10 years, maybe two rooms could accommodate them. Now, 15 to 20 percent of rooms can accommodate them.”

Obese patients face unique challenges, including the need for larger and sturdier beds and wheelchairs and other heavy-duty equipment. Because larger wheelchairs may not fit through the doors of a standard-size bathroom, patients are often bathed in their rooms, a cumbersome process that often requires two to three caregivers.

“Standard-size rooms don’t have enough room for appropriate equipment to treat these patients,” said Geri Johnston, a nurse and the bariatric surgery program coordinator at the teaching hospital at the Medical University of South Carolina in Charleston. “You have to have enough room to have the right equipment. That may not fit in a normal hospital-size room, and certainly not in a shared room, let alone a shared bathroom.” Obese patients often have other serious, simultaneous medical conditions that require specialized care.

Tonya Rackett, 43, a research nurse, recalled feeling very uncomfortable while recovering from routine gallbladder surgery in a small room she shared with two other patients at UHS Wilson Medical Center in Johnson City, N.Y. “I was morbidly obese,” she said. “When they had visitors, it was impossible to get to the bathroom. I felt the room didn’t really fit me, and I was frustrated.”

In the surgery suite, she said, “they had these tiny surgical room nurses. The surgery bed was very small. I felt like I was hanging over on both sides.”

“Most hospitals were not built for larger people,” said Dr. David Provost, a surgeon who worked at Parkland Hospital until 2008 and who now performs bariatric surgery in the Dallas area. Rather than clustering or relegating obese patients to a separate bariatric unit or wing, he believes that such patients are far better off when they can recover in a clinical area based on their surgical procedure or disease process. “That is the trend,” he said.

Each of Parkland’s spacious, 273-square-foot rooms was designed to more effectively treat heavier patients, starting with the six-foot-wide door opening to comfortably accommodate wider wheelchairs and beds.

Labeled advanced smart beds by their manufacturer, the heavy-duty beds accommodate people weighing up to 500 pounds and wirelessly collect, record and transmit relevant patient data to the hospital’s electronic medical records, including the patient’s weight and head position, as well as the bed’s height, brake position and side-rail status. An alarm alerts caregivers if a patient tries to leave the bed.

For the greatest flexibility and patient privacy, architects placed the 50-square-foot private patient bathrooms along an exterior wall. Every bathroom has a four-foot-wide doorway, a heavy-duty, floor-mounted commode and an extra-large shower with a large seat.

“The presence of these articles makes a huge difference to the patient,” said James Zervios, vice president for marketing and communications for the Obesity Action Coalition, an advocacy group.

Separately, 100 rooms — about four per floor — are equipped with a motorized lift that can accommodate patients up to 1,000 pounds. Running along a ceiling-mounted track, its hammock-like sling can more easily and safely lift and transport the hospital’s heaviest patients.

Every floor also has a portable bariatric lift that can accommodate patients of any weight who require gentle transport, including those who have had spine surgery or joint replacement. Lifts also benefit nurses and other caregivers because they reduce the occurrence of strains, muscle pulls and other work-related injuries directly related to moving and transporting heavier patients.

While the patient rooms at most hospitals are mirror images, every room at the new Parkland Hospital is not only the same size but also “same-handed” — furnishings, patient charts and medical equipment are always on the same side. Research indicates that such an approach helps reduce the incidence of clinical errors, as hospital staff no longer need to hunt and peck for charts and equipment.

Patients and staff members are not the only ones benefiting from the changes at Parkland. The chairs in each room can accommodate a 400-pound visitor. And beneath a picture window with a view of the Dallas skyline, the padded cushion of a love seat folds into a visitor’s bed that can take 750 pounds.